Healthcare Provider Details

I. General information

NPI: 1154782142
Provider Name (Legal Business Name): EMANUEL HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W MAIN ST
GRASS VALLEY CA
95945-6410
US

IV. Provider business mailing address

714 W MAIN ST
GRASS VALLEY CA
95945-6410
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-9800
  • Fax:
Mailing address:
  • Phone: 530-477-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: